Provider Demographics
NPI:1235653213
Name:REGAN, JESSICA (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E HENNEPIN AVE UNIT 212
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3006
Mailing Address - Country:US
Mailing Address - Phone:763-221-6189
Mailing Address - Fax:952-922-2049
Practice Address - Street 1:6363 FRANCE AVE S STE 402
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2142
Practice Address - Country:US
Practice Address - Phone:952-903-1319
Practice Address - Fax:952-922-2049
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN196661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical